Forceps for handling/holding a mobile wedge plate

ABSTRACT

The present invention includes devices, systems and methods for the storage, retrieval and placement of plates having wedges. A wedge plate tray includes an upper portion and at least one recessed portion, the recessed portion including a cavity sized to house the wedge and an additional cavity sized to accommodate placement and movement of an arm of an insertion instrument. The insertion instrument includes two arms connected at a hinge, a tip of each arm including a mating connector sized to engage a complementary mating connector on the wedge. In one embodiment of the method, the insertion instrument can be used to place the wedge plate in an osteotomy and where the wedge is a mobile wedge, a plate component can be adjusted to a desired position for securement while using the insertion instrument to hold the wedge in place in the osteotomy.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of the filing date of U.S.Provisional Patent Application No. 62/303,063, filed Mar. 3, 2016, thedisclosure of which is hereby incorporated by reference herein.

BACKGROUND OF THE INVENTION

The present invention relates to improved devices, systems and methodsfor storing and retrieving implants and performing osteotomy procedures.

An osteotomy is a surgical procedure whereby a bone is cut to shorten,lengthen or otherwise change its alignment. It may be performed tocorrect deformities such as a hallux valgus, a progressive forefootdeformation, or to relieve pain from arthritis, especially in the hip orknee. The procedure usually entails either: the removal of a typicallywedge-shaped portion of a bone by cutting transverse to the long axis ofthe bone, whereupon the bone can be “closed,” i.e., fused together atthe space and allowed to heal; or a simple partial cut transverse to thelong axis, whereupon the bone can be “opened” and fixated with anappropriate device. For example, an implant may be inserted into thespace, and/or a bone plate may be affixed to the bone adjacent to thespace, to maintain or increase the space. The “closing” or “opening”changes the spatial relationship between the remaining portions of thebone in order to adjust its alignment or length.

Open-wedge osteotomy refers to a specific type of osteotomy procedure inwhich a partial cut transverse to the long axis of the bone is made andsubsequently opened. The correction is maintained by using anappropriate fixation device, such as, for example, a bone plate withscrews. Additionally, a wedge can be included with the bone plate tofill the space that is opened so that the bone can return to aload-bearing state and also to facilitate bone healing. The implantedwedge helps to maintain the opened space by allowing the bone totransmit load to the wedge, thereby preserving the surgeon's aimedreduction or expansion of the angle of the bone before final locking ofthe plate with bone screws. The wedge also keeps the osteotomy open toallow insertion of locking or non-locking bone screws into the bone tofix the bone plate to the bone.

These procedures have typically been performed using static wedgeplates, such as that shown in FIGS. 1A-1D. The static wedge plates showninclude a bone plate 2 and a wedge 4 integrally formed on a bottomsurface of the plate. The bone plates also include a plurality of holesfor the placement of screws. The holes on the bone plate are positionedso that the plate is securable on both sides of an osteotomy 5 as isshown in FIG. 1E, where the static wedge plate is implanted in a footbone. Proximal to each end, the bone plate 2 further includes a holeadapted for placement of K-wire. U.S. application Ser. No. 14/793,215(“the '215 application”), the disclosure of which is hereby incorporatedby reference herein in its entirety, discloses similar plates wherein awedge is formed separately from the plate and thereafter assembledthereto. This design allows for the situation of the wedge at varyingpositions with respect to the plate.

Placement of existing static wedge plates involves orienting the platesuch that the integrally formed wedge extends into the resultant spaceof the bone created by making one or more transverse cuts. Thisplacement may utilize any number of tools or can simply be performed byhand by the surgeon. Placement of a mobile wedge plate like thatdisclosed in the '215 application is somewhat more difficult. Not onlyis it necessary to guide the wedge into the resultant space, but it isalso necessary to maintain the wedge in position with respect to theplate.

Thus, a need exists to improve the instruments, devices, systems andmethods used to perform osteotomy procedures to reduce errors inplacement of implants, to reduce the need for additional intraoperativeprocedures, and to improve storage and retrieval of implants.

BRIEF SUMMARY OF THE INVENTION

The present invention generally relates to systems and methods for thestorage and placement of bone plates used in osteotomies. A first aspectof the invention is an implant system that includes a bone plate, awedge and an insertion instrument. The bone plate is configured to besecured to a bone. The wedge is coupled to the bone plate and includesone of a cavity or a projection. The insertion instrument includes anelement complementary to the wedge so that if the wedge has a cavity,then the insertion instrument has a projection, and vice versa. Thefeatures of the wedge and the insertion instrument are configured sothat the insertion instrument engages with the wedge.

In another embodiment, the wedge is moveable with respect to the boneplate. In yet another embodiment, the insertion instrument includesfirst and second arms pivotally connected to each other. The first armincludes one of a first cavity or a first projection. This cavity orprojection engages with the other of the first cavity or firstprojection located on the wedge. Similarly, the second arm includes oneof a second cavity or a second projection. This cavity or projectionengages with the other of the second cavity or second projection locatedon the wedge. In yet another embodiment, the insertion instrument canengage the wedge in a first configuration such that the bone plate ismoveable with respect to the insertion instrument and in a secondconfiguration such that the bone plate is fixed with respect to theinsertion instrument.

In other embodiments, the wedge includes first and second cavities orfirst and second projections. The first cavity or projection is formedon a first surface of the wedge and the second cavity or projection isformed on a second surface of the wedge opposite the first surface. Inother embodiments, the system also includes a tray. The tray is adaptedto hold the bone plate where the bone plate is coupled to the wedge. Inyet another embodiment, the tray includes an instrument cavity. Theinstrument cavity is adapted to receive a portion of the insertioninstrument. It is also adapted to allow the insertion instrument toengage the wedge. In a variant, the tray further comprises a recessedportion to hold the bone plate. The recessed portion includes at least afirst recessed surface and a second recessed surface. The second recessis recessed relative to the first and is adapted to hold the wedge inplace when the wedge is stored in the tray.

Another aspect of the invention is a tray for the storage of wedgeplates. The tray includes a body with first and second recessedportions, as well as a cavity. The first recessed portion has aperimeter sized to accommodate a bone plate. The second recessed portionis recessed relative to the first recessed portion and includes aperimeter sized to accommodate a wedge. The cavity is adjacent to and incommunication with the second recessed portion. The cavity is sized sothat an insertion instrument can be disposed within the cavity and canbe manipulated while disposed.

In another embodiment, the tray also includes a second cavity so thatthere is a first and second cavity in the tray. The cavities are locatedso that each extend from different sides of the second recessed portion.In a variant, a bottom surface of the first and second cavities are at adepth different than a depth of the first recessed portion. In a furthervariant, each cavity includes a length measured from an edge of thefirst recessed portion to a tip and is defined by two parallel wallsbetween the edge of the first recessed portion and the tip. In yetanother variant, the length and depth of each cavity are sufficient foran adjustment of an arm of the insertion instrument along the length anddepth of the cavity.

In yet another aspect of the invention, a first embodiment provides asurgical method that entails engaging an insertion instrument with awedge movably connected to a bone plate; orienting the wedge withrespect to the bone plate; and manipulating the insertion instrument toplace the wedge between first and second bone portions and the plateagainst the two bone portions.

In another embodiment, the wedge and bone plate are held in a tray. Withthe elements in this position, the engaging step further includesplacing a portion of the insertion instrument in a first position intofirst and second cavities in the tray. This is followed by moving theinsertion instrument to a second position where the wedge is captured bythe insertion instrument. In a variant, the engaging step furtherinvolves a first mating connector of the insertion instrument engaging acomplementary second mating connector of the wedge and a third matingconnector of the insertion instrument engaging with a complementaryfourth mating connector of the wedge.

In another embodiment, the engaging step includes engaging both thewedge and the bone plate with the insertion instrument. That is, boththe wedge and the bone plate are engaged at the same time. In otherembodiments, the orienting step occurs prior to the engaging step. Instill further embodiments, an additional resecting step is taken where abone is resected to create the first and second bone portions. In otherembodiments, additional steps are taken including placing a first screwthrough the bone plate and into the first bone portion and placing asecond screw through the bone plate and into the second bone portion.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A-D illustrate several prior art static wedge plates.

FIG. 1E illustrates one of the static wedge plates of FIGS. 1A-Dimplanted in a foot bone.

FIG. 2 illustrates a perspective view of a mobile wedge plate accordingto one embodiment of the present invention.

FIG. 3 illustrates a perspective view of a wedge holding forceps of thepresent invention engaged with the mobile wedge plate of FIG. 2.

FIG. 4 is a close up view of an engagement between the forceps andmobile wedge plate of FIG. 2.

FIG. 5 illustrates a wedge plate tray according to one embodiment of thepresent invention having a plurality of mobile wedge plates disposedwithin recessed portions thereof.

FIG. 6 illustrates a close up view of a recessed portion of the wedgeplate tray of FIG. 5.

FIG. 7 illustrates a close up cross sectional view through a recessedportion of the wedge plate tray of FIG. 5 with a mobile wedge platedisposed therein.

FIG. 8 illustrates the forceps of FIG. 3 engaging a mobile wedge platedisposed within a recessed portion of the wedge plate tray of FIG. 5.

DETAILED DESCRIPTION

Although the embodiments described below and shown in the figures aredirected to specific implants and procedures, it is to be understoodthat the concepts and novelty underlying the present invention could beutilized for other types of procedures, including other osteotomyprocedures such as Cotton osteotomies, Evans osteotomies, high tibialosteotomies, and other open wedge osteotomies. Moreover, althoughdescribed in connection with the correction of hallux valgus in thefoot, the present invention has application in other areas of the humanbody, including the ankle, knee, hip, spine, and even maxillofacialareas, such as the jaw or chin. Likewise, the particular structuresdepicted are merely exemplary, and may vary widely while still employingthe inventive features of the present invention.

The various aspects of the invention described below are suitable foruse with a wide variety of wedge and bone plate combinations where thewedge is coupled to the bone plate. One exemplary combination includes awedge coupled to a bone plate where the wedge is longitudinallytranslatable and rotatable relative to the bone plate (hereinafter,“mobile wedge plate”), but could still have applicability to plates withintegrally formed wedges. FIG. 2 illustrates one embodiment of themobile wedge plate 10 that is adapted for use with the wedge holdingforceps and wedge plate tray described herein. The mobile wedge plate 10includes a bone plate 12 and a wedge 14.

As shown, bone plate 10 includes a track 16 positioned and sized toallow for translation 41 and rotation 42 of the wedge 14. The bone platealso includes holes 18 sized for the placement of screws through theplate and into surrounding bone. Bone plate 12 also includes at leastone hole 19 adapted for the placement of K-wire. In other variants, theholes 18, 19 can be sized for the placement of a variety of screw orK-wire types, sizes and quantities, and can be situated in anyconfiguration on the plate. Likewise, although plate 10 is shown for aparticular use in the foot, it can exhibit any configuration necessaryfor use elsewhere in the body.

The wedge 14 includes an engagement portion having a stem and a head,like that more fully disclosed in the '215 application. The wedge ispositioned at an approximately orthogonal position relative to a lengthof the bone plate 12 and is coupled to the bone plate 12 through theengagement portion wherein the stem extends through the track 16 and alip of the head keeps the stem and the wedge from separating from thebone plate. The wedge 14 is longitudinally translatable along the lengthof the track 16. As the stem has a generally round cross section, thewedge 14 is also rotatable at any location on the track 16. In avariant, the wedge can further be adapted to include a locking elementthat can be used to lock the wedge at a particular angle or positionrelative to the bone plate.

Outer surfaces of the wedge 14 are generally planar. On the two oppositefacing surfaces perpendicular to the length of the bone plate, the wedgeincludes wedge mating connectors 15. In the embodiment shown in FIG. 2,the wedge mating connectors are remote from corners of the wedge 14. Ina variant, only the lateral sides of the wedge mating connectors areremote from edges of the wedge 14. In another variant, the wedge matingconnectors are remote from the lateral sides and bottom edges of thewedge 14, but not the top edges proximal to the bone plate 12. In stillfurther variants, the wedge mating connector on one side of the wedge isa different size than the wedge mating connector on the other side ofthe wedge. In yet another variant, the wedge mating connector on oneside of the wedge is a different shape than the wedge mating connectoron the other side. One example of such wedge mating connectors 15 arewedge cavities as shown in FIG. 2. In another example, the wedge matingconnectors are projections. Mating connectors in the form of projectionsinclude pins, elevated portions, bosses or other shapes configured to beengagable with a complementary cavity in an instrument. Complementarymating connectors included on a tool or instrument are described indetail below.

An insertion instrument in the form of wedge holding forceps 20 is shownin FIG. 3. Forceps are a typical instrument for use in picking up andplacing implants, such as plates, into and through surgical openings,for instance, in the placement of wedge plates during osteotomyprocedures. The wedge holding forceps 20 include two componentsconnected at a hinge 21 that functions as a pivot point. The hinge asshown in FIG. 3 is a Pin-type hinge. In a variant, the hinge can be anytype known to those of skill in the art. Each component has unitaryshading as shown in FIG. 3 and includes a ring handle 22, a ratchet 23and an arm 25.

The ring handle 22 of each component is generally circular and allows auser's finger(s) to pass through for grip. The ring handle is connectedto the arm 25 at one location, with the arm 25 extending from the ringhandle on a generally linear path. The ratchet 23 extends from the arm25 of each component at a location proximal to the ring handle 22. Theratchet has a length so that in many of the wedge holding forcepspositions, it overlaps with a longitudinal axis of the arm of theopposing forceps component. The length of the ratchet 23 is arcuate sothat in a direction toward the opposing component of the forceps, itcurves away from the ring handle on the opposing component. One surfaceof each ratchet 23 includes serrations 24 adapted to interconnect withserrations on the opposing component. In FIG. 3, the serrations 24 onthe ratchet of one component face upward as shown and the serrations 24on the other component face downward so that the respective serrationsface each other. This provides interconnectivity between the componentsof the forceps in open and closed positions and positions in between.

The arm 25 of each component includes an upper portion 26 and a lowerportion 27. The upper and lower portions are divided by the hinge 21.The upper portion 26 is generally linear and has a length extending fromthe ring handle 22 to the hinge 21. The lower portion 27 is generallylinear through approximately the same axis as the upper portion and hasa length extending from the hinge 21 to a tip. Although the lowerportion 27 of the arm is generally linear, the tip of the arm includesan instrument mating connector 28, complementary to the wedge matingconnector 15. One example of such an instrument mating connector is aprojection 28, best shown in FIG. 4, having the appearance of a tooth.The projection 28 has a length extending inward from the lower portion27 toward the opposing component of the wedge holding forceps at anangle to the length of the lower portion. A cross sectional shape of theprojection 28 of the arm is rectangular and is sized to engage thecomplementary wedge mating connector 15 of the wedge 14 forming part ofthe mobile wedge plate 10, in this case, a wedge cavity. The projection28 includes an end face 29 that is perpendicular to a length of theprojection so that a longitudinal axis of the length of the projectionpasses through the end face 29. In another variant of the projectionexample, a projection that engages with the wedge cavity is an extensionof projection 28 and has a smaller cross section than projection 28.

In another example, the projection can be sized so that a cavity orrecess exists within the end face of the projection. The cavity can besized to engage with the corresponding mating connector of the wedgeplate, in this case, a projection, so that the cavity of the instrumentreceives the projection of the wedge in a secure manner. The cavity canbe any shape provided it complements the shape of the projection. In avariant of this example, the cavity can be directly on the surface ofthe lower portion 27 of the arm itself so that the insertion instrumentincludes no projections. In such a variant, the projections of the wedgeare long enough to ensure engagement between the projections of thewedge and the cavity of the instrument where closure of the arms of theinstrument is limited by a width of the bone plate. Of course, in otherembodiments, the mating connector of the insertion instrument can be ofany shape suitable for engaging the mating connector of the wedge plate.It is also contemplated to provide wedge 14 with one cavity and oneprojection and forceps 20 with one projection complementary to thecavity of the wedge and one cavity complimentary to the projection ofthe wedge. Additionally, more than one of either the cavity orprojection may be provided in each component.

As shown in FIG. 4, the longitudinal axis of the instrument matingconnector 28 is at an acute angle relative to a longitudinal axis of thelength of the lower portion 27 of the arm. In a variant, the anglebetween the longitudinal axis of the instrument mating connector 28 andthe longitudinal axis of the lower portion 27 can be ninety degrees. Inanother variant, it can be greater than ninety degrees. In still furthervariants, a plane through the end face 29 of the instrument matingconnector 28 can be at an acute angle relative to the longitudinal axisof the projection. In other variants, the plane through the end face 29can be at an obtuse angle relative to the length of the instrumentmating connector 28. The instrument mating connector 28 on the arm ofone component of the wedge holding forceps is the same size and shape asthe instrument mating connector 28 on the arm of the opposite component.In a variant, however, the instrument mating connector on one arm can bea different size than the instrument mating connector on the other arm.In yet another variant, the instrument mating connector on one arm canbe a different shape than the instrument mating connector on the otherarm.

In addition, it is to be understood that the arm 25 of each componentshown in FIG. 3 is monolithic between the handle 22 and the instrumentmating connector 28. In this way, the hinge 21 that connects each arm 25ensures that movement of the instrument mating connector 28 on each armis directly correlated to the movement of each handle 22. In otherwords, the connection of the arm 25 of each component to the hinge 21allows each arm to pivot about the hinge 21. Of course, in variants, thearm of each component can include two or more sub-components to completethe arm structure and can be connected together using any means known tothose of ordinary skill in the art. It is also contemplated to formforceps such that they open and close in different fashions. Forinstance, forceps according to the present invention could include athree bar linkage that would allow them to open and close with the armsremaining in a parallel orientation.

In any one of the above embodiments, the cross sectional shape of thearms, ratchet and/or handles can be square, rounded, elliptical or anyother shape known to those of ordinary skill in the art. The ratchet ofone component can be any structure, either monolithic with the arm ofeach component or separate, that functions to interconnect with theratchet of the other component. The handles can be oval in shape or anyother handle shape or type known to those of ordinary skill in the art.In other embodiments, the insertion instrument can be any tool with twoarms where each arm is adapted to include a mating connector at anengagement end and has a range of movement between an open and closedposition so that movement is sufficient to engage a wedge plate and tofit within instrument cavities in the tray as described herein.

One advantage of the insertion instrument is that it allows a user toaccurately adjust and hold the wedge relative to the bone plate of themobile wedge plate prior to final positioning in the osteotomy. This canbe prior to insertion of the wedge into the osteotomy or while the wedgeis in the gap between bones in the osteotomy. In both circumstances, theinsertion instrument holds the wedge in place while another means areused to rotate the bone plate relative to the wedge. This significantlyreduces the need for intraoperative procedures to adjust the mobilewedge plate as it can be adapted to the particular osteotomy at issueprior to final placement. For example, whether the osteotomy isperpendicular to a length of the subject bone or whether it is atanother angle, the angle between the bone plate and the wedge can beadjusted to match the actual conditions at the surgical site.

Another advantage of the insertion instrument is that it can be used tohold the wedge in place to rotate the bone plate to an extent sufficientfor accurate alignment of the bone plate with the bone to be secured.With the bone plate in proper position for securement, the insertioninstrument can continue to hold the wedge while the user performspreliminary plate fixation via drilling. In the same way, the wedge canbe held while the user performs screw insertion to secure the bone plateto the bone. It is also envisioned that the insertion instrument can beconfigured such that upon engagement with the wedge, the bone plate isalso engaged. This can result in a fixed construct upon application ofthe insertion instrument to the bone plate and wedge. A surgeon canalign the wedge in the desired position with respect to the plate beforeapplication of such insertion instrument. This is advantageous in thatit takes an otherwise unfixed set of components and fixes them forplacement within the body.

In another aspect, the present invention relates to a wedge plate trayadapted to receive wedges coupled to bone plates and the insertioninstrument. One embodiment of the wedge plate tray 30 is illustrated inFIG. 5. The wedge plate tray 30 is generally rectangular in shape andincludes a maximum depth that is greater than the depth of wedgescoupled to bone plates. A top surface includes a generally planar outerportion 31 and a plurality of recessed portions 32. In FIG. 5, each ofthe recesses adjacent to a numeric marking represents a recessed portion32. For example, “0”, “2”, “3” and so on. Each recessed portion 32extends over an area bounded by the outer portion 31 of the top surfaceso that no recessed portion 32 extends to a perimeter of the tray 30.The surface area of each recessed portion 32 is slightly larger than asurface area of a bone plate 12 and each recessed portion is oriented sothat adjacent recessed portions are parallel to one another and a lengthof each recessed portion is perpendicular to a length of the tray 30.However, the recessed portions 32 are preferably sized to allow for asnug fit with the bone plate and wedge in order to hold them in positionwithin the tray. Tray 30 can also include a cover in the form of aremovable lid or even be configured similar to a blister pack with apeel off cover.

As best shown in FIG. 6, each recessed portion includes a step so thatone side is recessed to a greater extent than the other. Thus, therecessed portion is divided into a deep recess 35 and a shallow recess33, where the step separates each. The depth and shape of the recess atdifferent locations on the recessed portion ensures that the mobilewedge plate 10 can be firmly secured into the tray 30. In other words,the plate is held securely in place by the shape of the recess in thetray. As shown in FIG. 5, the wedge plate tray 30 includes additionalcavities 34 on the recessed surfaces. FIG. 6 illustrates that two of thecavities 34 are located in the shallow recess 33 of the recessed portionwhile the other two are in the deep recess 35. Each cavity is sized topermit water passage. Water passage can occur, for example, whencleaning the tray 30.

Within a surface of the deep recess 35 is yet another recessed surfaceto accommodate placement of the wedge coupled to the bone plate when thebone plate is positioned in the wedge plate tray 30. As shown in FIGS. 6and 7, a wedge recess 36 is generally rectangular in shape with beveledcorners and is centered on a width of the recessed portion 32. Althoughgenerally speaking, as described above, the outer perimeter of therecessed portion 32 is the shape of a perimeter of the top surface ofthe bone plate 12, the recessed portion does extend outward from thisperimeter at two locations. At each of these locations is a tray cavityfor an instrument 38 having a length perpendicular to a longitudinalaxis of the wedge recess 36. The length of the cavity extends from theperimeter of the recessed portion to a tip and is defined by parallelwalls, visible in FIGS. 6 and 8. The instrument cavities 38 extend to adepth of the deep recess 35 and are open into the recessed portion 32 sothat access between the instrument cavities 38 and the deep recess 35 isunimpeded throughout the depth of the recess. In other words, theinstrument cavities 38 are in communication with the deep recess 35.Each cavity 38 is located on an opposite side of the perimeter of therecessed portion 32. The instrument cavities 38 are sized to accommodatethe insertion of each arm of the wedge holding forceps 20 from bothsides of the mobile wedge plate 10. The size of the instrument cavities38 is sufficient not only to allow insertion of each arm, but further toallow manipulation of the handles 22 so that the mobile wedge plate 10can be retrieved or released while the forceps 20 are inside thecavities 38. Other embodiments with different cavity 38 geometry arediscussed in detail below.

In other embodiments, the instrument cavities 38 can be recessed to alesser or greater extent than the deep recess 32. In a variant, thedepth of the instrument cavity on one side of the recessed portion canbe different than the depth on the other side. In any one of the aboveembodiments, the length of mobile wedge plates can be oriented so that acenterline through the length of each plate passes through a commonaxis, and/or the recessed portions can include additional cavities. Ofcourse, other embodiments can include additional cavities or recessedportions extending outward from the outer perimeter of the recessedportion 32.

In another embodiment, the wedge plate tray includes an outer portionand a single recessed portion sized to accommodate a single mobile wedgeplate. In other embodiments, the wedge recess 36 can be elongated toaccommodate longitudinal movement of the wedge 14 along the track 16 ofthe bone plate 12 while the mobile wedge plate is secured in the tray30. A width of the instrument cavities 38 can also be sized toaccommodate rotation of the arms 25 of the wedge holding forceps 20about the center of the recessed portion 32 of the tray. Through thecombination of the enlarged wedge recess 36 and instrument cavities 38,the wedge of a mobile wedge plate secured in a tray may belongitudinally translated and/or rotated relative to the bone platewhile secured in the tray 30 using the forceps 20.

In any one of the above embodiments, further to the recessed portionsalready described, the wedge plate tray can include additional recessedportions. Additional recessed portions can include one or more recessedlevels and can further include additional cavities within the one ormore recessed levels. In any one of the above embodiments, the pluralityof recessed portions, each adapted for the storage of a wedge plate, canbe of varying size with respect to each other. For example, one recessedportion can be sized for the placement of a mobile wedge plate includinga bone plate five inches in length, while another recessed portion canbe sized for the placement of a mobile wedge plate including a boneplate ten inches in length. As these examples illustrate, theembodiments contemplated herein can also include a wedge plate tray withrecessed portions sized for the placement and storage of plates of asize other than that depicted in FIG. 5. In any one of the aboveembodiments, the wedge plate tray can be adapted for use with wedgescoupled to bone plates that are not mobile wedge plates.

Advantages of the wedge plate tray include that it allows for the securestorage of bone plates with wedges secured to the bottom thereof.Another advantage of the wedge plate tray is the unique combination of arecessed portion for the placement of the bone plate into the tray, anadditional recessed surface in the recessed portion for the insertion ofthe wedge coupled to the bone plate, and additional cavities locatedadjacent to the recessed portion so that an insertion instrument can beinserted to retrieve the bone plate.

In yet another aspect, the present invention relates to a method ofusing the wedge holding insertion instrument in connection with thewedge plate tray to retrieve and place a wedge coupled to a bone platefor surgical procedures. In one embodiment, one or more mobile wedgeplates 10 are stored in the recessed portions 32 of the wedge plate tray30, as shown in FIG. 5. The mobile wedge plates 10 are positioned in thetray so that the wedge of each mobile wedge plate fits into the wedgerecess 36 of the recessed portion 32. To retrieve one of the mobilewedge plates 10 for placement at a surgical site, such as an osteotomy,the user utilizes wedge holding forceps 20 as shown in FIG. 3 andadjusts the arms 25 into an open position by spreading the ring handles22 apart from one another until the lower portions 27 of the arms areslightly wider than the width of the mobile wedge plate 10. The userthen lowers the forceps so that a portion of each arm 25 enters aforceps cavity 38 of the tray 30, as shown in FIG. 8. With a portion ofthe arms in place within the forceps cavities 38, the user brings thering handles 22 closer together so that the instrument mating connector28 of each arm 25 engages with one of the complementary wedge matingconnectors 15 of the wedge 14, as shown in FIG. 4. With the armsengaged, load from the mobile wedge plate is borne by the matingconnector of each arm as the user lifts the forceps to remove the mobilewedge plate 10 from the wedge plate tray 30. In a variant, the user canuse the forceps 20 to move the wedge 14 along the track 16 of the plate12 or rotate the wedge relative to the plate prior to lifting theforceps 20 from the tray 30. Alternatively, the wedge can belongitudinally translated or rotated relative to the plate prior tobeing engaged by the forceps. In another variant, the user canmanipulate the arms once partially inserted into the forceps cavities 38to assist in locating the wedge mating connectors 15 of the wedge forengagement. In yet another variant, forceps 20 may not only engage wedge14, but also a portion of the bone plate in order to fix both componentsin position with respect to the forceps 20.

With the wedge holding forceps 20 engaged to the mobile wedge plate 10and the mobile wedge plate removed from the tray 30, the forceps arethen used to transport the mobile wedge plate 10 to a desired surgicalsite. The user then lowers the forceps 20 so that the arms of theforceps and the wedge 14 are positioned between bone on both sides ofthe osteotomy. In this position, the bone plate 12 traverses both sidesof the osteotomy. Steps known to those of skill in the art are then usedto secure the bone plate 12 of the mobile wedge plate 10 to the bone.For example, screws 18 are inserted into the bone through each hole 18in the bone plate 12. In one variant, the osteotomy includes resectionof a single bone to create first and second bone portions.

In another embodiment, the method of the above embodiment can furtherinclude the step of rotating and/or translating the wedge relative tothe bone plate while the user continues to hold the wedge holdingforceps to secure the wedge after the mobile wedge plate is removed fromthe tray. Rotating or translating of the wedge can be done prior to oreven after placement of the mobile wedge plate into the osteotomy. Thisensures proper alignment of the mobile wedge plate to the osteotomy andadjacent bone structure for both placement of the wedge and securementof the bone plate to the desired bone surfaces. In other embodiments,where forceps are designed to hold the plate and wedge in a fixedposition, this alignment can be done after removal of the forceps.

In another embodiment, a method is contemplated where the wedge holdingforceps can be used to retrieve the mobile wedge plate and transport itto the wedge plate tray. The user first retrieves the forceps and thenadjusts the arms as described above to position the forceps for theretrieval of the mobile wedge plate. The forceps are then lowered andclosed as necessary to engage with the mobile wedge plate. With thewedge engaged, the forceps are used to transport the mobile wedge plateto the wedge plate tray. As above, the user then lowers the forceps sothat each arm enters the forceps cavity of the tray. With the arms inplace within the forceps cavities, the user opens the ring handlesmoving them further apart, and thus disengaging the teeth of the armsfrom the wedge of the mobile wedge plate. The user lifts the forceps,leaving the mobile wedge plate stored in position within a recessedportion of the tray.

In yet another embodiment, static wedge plates can be retrieved andtransported to a desired surgical site or to the wedge plate tray. Inany of the above embodiments, alternatives to the wedge holding forcepsdescribed herein can be used to perform the method, provided that thealternative insertion instrument has the elements as described in thevarious embodiments for the insertion instrument described above.

One advantage of the methods described includes reduced difficultieswhen placing a mobile wedge plate into an osteotomy with an insertioninstrument. Namely, reduced difficulty due to a lack of visualization ofthe wedge during the placement process. This is because the user isassured that the wedge is well secured and can identify the orientationof the wedge through the alignment of the arms of the insertioninstrument. In this way, the user can rotate the bone plate relative tothe wedge with confidence when using the insertion instrument asdescribed herein.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

1. An implant system comprising: a bone plate configured to be securedto a bone; a wedge adapted to be coupled to the bone plate, the wedgehaving one of a cavity or a projection; and an insertion instrumenthaving the other of the cavity or the projection and configured toengage the one of the cavity or the projection of the wedge.
 2. Theimplant system of claim 1, wherein the wedge is moveable with respect tothe bone plate.
 3. The implant system of claim 1, wherein the insertioninstrument further comprises first and second arms pivotally connectedto each other, the first arm including one of the cavity or theprojection and configured to engage the other one of the cavity or theprojection located on the wedge and the second arm including one of asecond cavity or a second projection.
 4. The implant system of claim 1,wherein the insertion instrument can engage the wedge in a firstconfiguration such that the bone plate is moveable with respect to theinsertion instrument and a second configuration such that the bone plateis fixed with respect to the insertion instrument.
 5. The implant systemof claim 1, further comprising a second cavity or a second projection onthe wedge, wherein the one of the cavity or projection is formed on afirst surface of the wedge and the second cavity or second projection isformed on a second surface of the wedge opposite the first surface. 6.The implant system of claim 1, further comprising a tray adapted to holdthe bone plate coupled to the wedge.
 7. The implant system of claim 6,wherein the tray further comprises an instrument cavity adapted toreceive a portion of the insertion instrument and allow the insertioninstrument to engage the wedge.
 8. The implant system of claim 7,wherein the tray further comprises a recessed portion to hold the boneplate, the recessed portion including a first recessed surface and asecond recessed surface recessed relative to the first recessed surface,the recessed portion adapted to hold the wedge in place when stored inthe tray.
 9. A tray for storage of wedge plates comprising: a bodyhaving a first recessed portion, the recessed portion having a perimetersized to accommodate a bone plate; a second recessed portion, the secondrecessed portion recessed relative to the first recessed portion andincluding a perimeter sized to accommodate a wedge; and a cavity locatedadjacent to and in communication with the second recessed portion, thecavity sized to accommodate an insertion instrument.
 10. The tray ofclaim 9, further comprising a second cavity, the cavity and the secondcavity each extending from an opposite side of the second recessedportion.
 11. The tray of claim 10, wherein a bottom surface of the firstand second cavities are at a depth different than a depth of the firstrecessed portion.
 12. The tray of claim 11, wherein each cavity includesa length measured from an edge of the first recessed portion to a tipand is defined by two parallel walls between the edge of the firstrecessed portion and the tip.
 13. The tray of claim 12, wherein thelength and depth of the first and second cavities are dimensioned sothat an arm of the insertion instrument is adjustable along the lengthand depth of the cavity.
 14. A surgical method comprising: engaging aninsertion instrument with a wedge movably connected to a bone plate;moving the wedge with respect to the bone plate; and manipulating theinsertion instrument to place the wedge between first and second boneportions and the plate against the two bone portions.
 15. The method ofclaim 14, wherein the engaging step includes: placing a portion of theinsertion instrument in a first position into first and second cavitiesin a tray holding the wedge and bone plate; and moving the insertioninstrument to a second position whereby the wedge is engaged by theinsertion instrument.
 16. The method of claim 15, wherein moving theinsertion instrument to the second position includes engaging a firstmating connector of the insertion instrument with a complementary secondmating connector of the wedge and a third mating connector of theinsertion instrument with a complementary fourth mating connector of thewedge.
 17. The method of claim 15, wherein moving the insertioninstrument to the second position includes engaging the insertioninstrument with both the wedge and the bone plate.
 18. The method ofclaim 14, wherein the adjusting step occurs prior to the engaging step.19. The method of claim 15, further comprising the step of resecting abone to create the first and second bone portions.
 20. The method ofclaim 15, further comprising the steps of placing a first screw throughthe bone plate and into the first bone portion and placing a secondscrew through the bone plate and into the second bone portion.